Provider Demographics
NPI:1588708317
Name:CLARKSON-HENDRIX, MICHAEL (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CLARKSON-HENDRIX
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:815 24TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2023
Mailing Address - Country:US
Mailing Address - Phone:518-265-5636
Mailing Address - Fax:518-430-3031
Practice Address - Street 1:815 24TH ST # 1
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2023
Practice Address - Country:US
Practice Address - Phone:518-265-5636
Practice Address - Fax:518-430-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0730511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical